title: Impact of HIV drug resistance on virologic and immunologic failure and mortality in a cohort of patients on antiretroviral therapy in China.
abstract: OBJECTIVE
  To study the dynamics of HIV drug resistance (HIVDR) and its association with virologic and immunologic failure as well as mortality among patients on combination antiretroviral therapy (cART) in China.
  
  
  METHODS
  We recruited 365 patients on cART in two rural Chinese counties in 2003-2004 and followed them every 6 months until May 2010.
  
  
  METHODS
  Virologic failure, HIVDR, immunologic failure and death were documented. We used Kaplan-Meier and the proportional hazards models to identify the timing of the events, and risk factors for mortality.
  
  
  RESULTS
  At the end of study, patients had been followed for 1974.3 person-years, a median of 6.1 years. HIVDR mutations were found in 235 (64.4%) patients and 75 died (20.5%, 3.8/100 person-years). Median time from cART to detection of virologic failure was 17.5 months, to HIVDR 36.6 months and to immunologic failure 55.2 months (≈ 18-month median interval between each adverse milestone). Being male, having a baseline CD4 cell count of less than 50 cells/μl and HIVDR were associated with higher mortality. Patients who developed HIVDR in the first year of treatment had higher mortality than those developing HIVDR later (adjusted hazard ratio 1.90, 95% confidence interval 1.01-3.48).
  
  
  CONCLUSIONS
  HIVDR was common and was associated with higher mortality among Chinese patients on cART, particular when HIVDR was detected early in therapy. Our study reinforces the importance of improving patient adherence to cART in order to delay the emergence of HIVDR and obviate the need to switch to costly second-line drug regimens too early.
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Hefei, Anhui, China.
authors.forename: Lingjie
authors.initials: L
authors.lastname: Liao
authors.forename: Hui
authors.initials: H
authors.lastname: Xing
authors.forename: Bin
authors.initials: B
authors.lastname: Su
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wang
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.forename: Xia
authors.initials: X
authors.lastname: Wang
authors.forename: Zhendong
authors.initials: Z
authors.lastname: Liu
authors.forename: Yanan
authors.initials: Y
authors.lastname: Lu
authors.forename: Shimei
authors.initials: S
authors.lastname: Yang
authors.forename: Quanbi
authors.initials: Q
authors.lastname: Zhao
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Ray Y
authors.initials: RY
authors.lastname: Chen
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D002681:China; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents